TIBIA FRACTURES. The tibia is subcutaneous. More commonly fractured and more commonly sustain an open fracture than any other bone.

MECHANISM OF INJURY. Indirect force ; spiral #. The fibula is usually fractured at a different area. Direct force ; transverse #. There may be a # of the fibula at the same level. The amount of communition varies according to the severity of the force. The risk of complications is directly related to the extend of soft tissue injury.

MECHANISM ……. Open #’s can graded according to the severity of injury ( Gustilo and Anderson). Grade 1 : clean small puncture wound due to bony spike. Grade 2 : wound > 1,0 cm. No extensive soft tissue injury. Moderately severe #. Grade 3 : severe bony and soft tissue injury and wound contamination.

MECHANISM…….. Grade 3 A : adequate soft tissue coverage. Grade 3 B : There is skin loss. Grade 3C : There is arterial injury requiring repair. The incidence of infection ranges from 1% for Grade I to 30% for Grade III. Tibial #’s usually take about 12 weeks to unite but many can take up to six months.

TREATMENT OF TIBIAL FRACTURES. Closed fractures: C/R plus A/K P.O.P. Usually done for stable #’s. C/R plus application of external fixator. Unstable / communited #’s can be managed by a fixator. The above #’s can also be managed operatively : ORIF / IM nailing. Bracing : stable #’s.

OPEN FRACTURES. Open #’s are never managed by ORIF. They must be debrided. Stabilization can be achieved by external fixation . EX.FIX. Can be used as a temporary device or as a definitive mode of treatment.

COMPLICATIONS. EARLY : Infection. Vascular injury. Compartment syndrome. LATE : Malunion. Delayed union. None union. Joint stiffness. Osteoporosis. Regional pain syndrome.

FRACTURE OF THE FIBULA ALONE. Spiral #’s are usually associated with knee or ankle #’s. Isolated fibular # is usually due to direct trauma or stress #. Usually treated conservatively ; analgesia. No further treatment is usually needed.

FRACTURES OF THE ANKLE. Fracture / fracture - dislocation of the ankle very common. Commonly due to a twisting injury. Commonly closed fractures. Often accompanied by severe swelling and blister-formation. They are regarded as Orthopaedic emergencies.

CLASSIFICATIONS. LAUGE- HANSEN : explains the mechanism of injury and the extend of the soft tissue disruption. Danis and Weber : This is an anatomical description. Explains fibular fracture in relation to the syndesmosis. TYPE A : The fibular # is below the syndesmosis. Caused by adduction / abduction.

CLASSIFICATION …. TYPE B : Oblique # running upwards from the syndesmosis. Caused by external rotation. TYPE C : # ABOVE the syndesmosis. Caused by abduction alone or abduction plus external rotation. The fracture can be as high as the fibular head. There is disruption of the interosseous membrane. It is very unstable.

PRINCIPLES OF TREATMENT. Fracture-dislocation . Diagnosis is clinical! Reduce the # before X-rays. Splint it. Closed # : ALL ankle #’s are treated operatively except those which have a minimally displaced lateral malleolus without medial tenderness; KEY THOUGHT. If the ankle is very swollen , splint it and elevate the leg. Definitive treatment is done once swelling has subsided.

PRINCIPLES OF TREATMENT ….. If the fracture is opened, first reduce the # ( most are fracture- dislocations). The # must be splinted. The patient must taken to theatre for Debride'ment. NB: the general principles of open fractures still hold true for open ankle #’s. Ankle #’s unite in about six to eight weeks. Patient must be N.W.B. Until union.

COMPLICATIONS. EARLY. Vascular injury. Late . Malunion. Non- union. Joint stiffness. Complex regional pain syndrome. Osteo-arthritis.